Research Article Maternal, Fetal, and Neonatal Outcomes in Pregnant Dengue Patients in Mexico Carlos Machain-Williams, 1,2 Eric Raga, 3 Carlos M. Baak-Baak, 1,2 Sungmin Kiem, 4 Bradley J. Blitvich , 5 and Celso Ramos 6 1 Laboratorio de Arbovirolog´ ıa, Centro de Investigaciones Regionales Dr. Hideyo Noguchi, Universidad Aut´ onoma de Yucat´ an, M´ erida, YUC, Mexico 2 Korean International Cooperation on Infectious Diseases (KOICID), Busan, Republic of Korea 3 Departamento de Atenci´ on M´ edica, Servicios de Salud de Veracruz-Coordinaci´ on Cl´ ınica M´ edica, Instituto Mexicano del Seguro Social, Xalapa, VER, Mexico 4 Department of Infectious Diseases, Inje University, Haeundae Paik Hospital, Busan, Republic of Korea 5 Department of Veterinary Microbiology and Preventive Medicine, College of Veterinary Medicine, Iowa State University, Ames, IA, USA 6 Centro de Investigaci´ on Sobre Enfermedades Infecciosas, Instituto Nacional de Salud P´ ublica, Cuernavaca, MOR, Mexico Correspondence should be addressed to Celso Ramos; cramos@insp.mx Received 14 August 2017; Revised 2 November 2017; Accepted 12 November 2017; Published 21 January 2018 Academic Editor: Marcelo A. Soares Copyright © 2018 Carlos Machain-Williams et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. To increase our understanding of the consequences of dengue virus infection during pregnancy, a retrospective analysis was performed on the medical records of all completed pregnancies (live births and pregnancy losses) at nine public hospitals in the Gulf of Mexico from January to October 2013. Eighty-two patients developed clinical, laboratory-confrmed dengue virus infections while pregnant. Of these, 54 (65.9%) patients were diagnosed with dengue without warning signs, 15 (18.3%) patients were diagnosed with dengue with warning signs, and 13 (15.9%) patients had severe dengue. Five (38.5%) patients with severe dengue experienced fetal distress and underwent emergency cesarean sections. Four patients delivered apparently healthy infants of normal birthweight while the remaining patient delivered a premature infant of low birthweight. Patients died of multiple organ failure during or within 10 days of the procedure. Severe dengue was also associated with obstetric hemorrhage (30.8%, four cases), preeclampsia (15.4%, two cases), and eclampsia (7.7%, one case). Tese complications were less common or absent in patients in the other two disease categories. Additionally, nonsevere dengue was not associated with maternal mortality, fetal distress, or adverse neonatal outcomes. In summary, the study provides evidence that severe dengue during pregnancy is associated with a high rate of fetal distress, cesarean delivery, and maternal mortality. 1. Introduction Dengue is the most prevalent mosquito-borne viral dis- ease afecting humans. Te causative agent is dengue virus (DENV; family Flaviviridae, genus Flavivirus), an Aedes- transmitted virus that occurs as four serotypes. Dengue is endemic in most, if not all, tropical and subtropical countries and about half of the world’s population is considered to be at risk [1–3]. According to one recent estimate, DENV is responsible for 390 million infections worldwide each year, of which 96 million produce clinical manifestations [4]. In Mexico, an estimated 139,000 symptomatic dengue episodes occur each year [5]. Te World Health Organization (WHO) previously clas- sifed dengue using three disease categories: dengue fever (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome [6]. Due to several shortcomings in the classif- cation scheme, most notably the underestimation of disease severity in some patients [7, 8], the WHO revised their guide- lines in 2009 [9]. Dengue cases are now classifed as either Hindawi BioMed Research International Volume 2018, Article ID 9643083, 8 pages https://doi.org/10.1155/2018/9643083